Great Ormond Street to look at home air pollution when diagnosing illnesses | Air pollution

Doctors at Great Ormond Street are being encouraged to consider air pollution levels at their patients’ home addresses when determining the causes of their illnesses, under an innovative trial scheme.

Data showing average annual air pollution levels in patients’ zip codes is embedded in patients’ electronic files, so clinicians can help families understand whether their child is at increased risk.

The initiative comes in response to criticism made by the coroner at the inquest into the death of Ella Adoo-Kissi-Debrah, who was nine when she died of asthma 10 years ago, and who in 2020 became the first person in the UK to listed air pollution. on her death certificate as cause of death.

The coroner, Philip Barlow, noted that Ella’s mother, Rosamund Adoo-Kissi-Debrah, “was not given information about the health risks of air pollution and its potential to worsen asthma”. In his report on preventing future deaths, Barlow warned that the adverse health effects of air pollution were not being adequately communicated by medical and nursing staff to patients and their carers, and called on medical staff to do more to protect families to inform about the dangers of air pollution.

Ella’s mother said the family “would have moved immediately” if she had been told her daughter was being killed by the air she was breathing.

The Great Ormond Street Hospital initiative was conceived by Mark Hayden, who works in the intensive care unit, with colleagues Nicola Wilson and Johanna Andersson. Hayden said there was previously a “significant knowledge gap” at the hospital about air pollution and its effects.

Data added to patients’ electronic records provides information on fine particulate matter (PM2.5) and nitrogen dioxide, and indicates whether these exceed World Health Organization safe levels. The information will encourage clinicians to consider whether air pollution is a factor in the patient’s illness. The pilot model has also recently been adopted by the Evelina Children’s Hospital, Guy’s and St Thomas’ and King’s College hospitals in London, so that air pollution is now visible on more than 2.5 million patients’ files.

In a report on air pollution and health, the chief medical officer for England, Chris Whitty, said last year that doctors need to do more to educate patients about the risks of air pollution, and noted that healthcare professionals need training to help discuss with patients how they can reduce the effects of air pollution. Ella’s coroner also called for better training of medical staff in the effects of air pollution.

At Great Ormond Street, the air pollution data only flashes if the levels in the child’s postcode are higher than the WHO 2021 safe limit guidelines. Aware that older doctors would have received almost no education about the health risks of air pollution, Hayden added links to background information pages to the files of patients who had overexposure. These pages cite WHO guidance explaining that air pollution is the “single greatest environmental threat to human health”, responsible for 7 million global deaths per year; the link that pops up points out that 40% of all preterm births (6 million) worldwide annually can be attributed to PM2.5.

There is also an option to create a letter to parents outlining the steps they can take to reduce their child’s exposure to air pollution and to provide them with a prototype letter to send to their MP which emphasizes that they have been warned by doctors that air pollution in their environment aggravates their child’s illness.

In its formal response to Ella’s inquest, the Royal College of Physicians admitted that clinicians often shy away from discussing the issue, noting: “Many patients and their families will not be able to make the changes that will have the most benefit – that is, change where they live, work and play – so doctors and other clinicians may be unsure about the benefits of such a conversation.”

Hayden agreed that staff have historically been uncomfortable talking about the health risks posed by air pollution. “Obviously, air quality is a little harder to fix than an infection. You can’t just give a little antibiotic,” he said.

Consultant respiratory pediatrician Andrew Turnbull said staff were starting to talk to patients with severe asthma about outdoor air pollution alongside discussions about tobacco and e-cigarette vapours, mold and moisture exposure, dust and pet allergies.

“We’ve had a long understanding of the strong links between poor air quality and adverse outcomes, but getting data at this level is new,” he said. Since most families do not have the option of moving to less polluted areas, discussions are limited to strategies to reduce an individual’s exposure to air pollution, perhaps around changing a patient’s route to school.

Because most respiratory diseases have complex, multifactorial causes, linking an individual’s disease to a single cause remains challenging, but the addition of air pollution data also had important research potential, helping staff to “understand how harmful pollution with link individual patient outcomes”, Turnbull added.

Hayden hopes the initiative will be introduced more widely, especially at GP practices. “It does bring up dilemmas because it would feel wrong to put that problem on a family who can’t do anything about it, but we’re trying to give clinicians the resources they need to have that conversation with families who then can use information to try to protect their children from further harm,” he said.